穿支皮瓣修复肢体软组织缺损的疗效观察

CLINICAL APPLICATION OF PERFORATOR FLAP IN REPAIRING SOFT TISSUE DEFECTS OF EXTREMITIES

目的探讨肢体穿支皮瓣修复肢体皮肤软组织缺损的方法及疗效。方法 2002年6月-2009年12月收治肢体皮肤软组织缺损81例。男69例,女12例;年龄13～75岁,平均54岁。外伤创面35例,伤后至入院时间为1h～45d;肢体体表肿瘤切除术后缺损19例,烧伤后瘢痕切除术后缺损27例。部位:小腿及足部56例,前臂及手25例。缺损范围3cm×3cm～23cm×18cm。采用腓动脉穿支皮瓣26例,桡动脉穿支皮瓣18例,足底内侧动脉穿支皮瓣18例,旋股外侧动脉穿支皮瓣19例。皮瓣切取范围为4cm×3cm～25cm×18cm。供区直接拉拢缝合或植皮修复。结果术后3～7d4例皮瓣部分坏死,均经换药、植皮修复后愈合;其余皮瓣及植皮均完全成活,创面Ⅰ期愈合。患者术后均获随访,随访时间1～16个月,平均9个月。皮瓣外形、质地、颜色与受区相匹配。肿瘤患者无复发。结论肢体穿支皮瓣手术操作简便,是修复肢体皮肤软组织缺损的有效方法之一。

Objective To investigate the method and effectiveness of perforator flaps in repairing soft tissue defects of extremities.Methods Between June 2002 and December 2009,81 patients with soft tissue defect of extremities were treated.There were 69 males and 12 females with an average age of 54 years（range,13-75 years）.Defect causes were injury in 35 cases（the disease duration ranged from 1 hour to 45 days）,tumor resection in 19 cases,and scar resection in 27 cases.The defect located at limb and foot in 56 cases,forearm and hand in 25 cases.The defect size ranged from 3 cm × 3 cm to 23 cm × 18 cm.The perforator flaps included the peroneal artery perforator flap in 26 cases,the radial artery perforator flap in 18 cases,the medial plantar artery perforator flap in 18 cases,and the lateral circumflex femoral artery perforator flap in 19 cases.The flap size ranged from 4 cm × 3 cm to 25 cm × 18 cm.The donor site was sutured directly or repaired by free skin graft.Results Partial necrosis of the flaps occurred in 4 cases at 3-7 days after operation,then the flap survived after expectant treatment.The other flaps and free skin grafts survived successfully,and the incisions healed by first intention.All patients were followed up 1 to 16 months with an average of 9 months.The appearance,texture,and colour of the flaps were similar to those of the donor site.Conclusion It is an effective method to use the perforator flap for repairing soft tissue defect of the extremities